Unexplained bruises and unclear consent: Doctor hit with $59K in fine and costs

A Prince Edward Island doctor found guilty of misconduct in his treatment of two patients has been fined $15,000 for one case and ordered to pay a total of $44,000 in investigation and hearing costs for both cases. Dr. Arvind Singh, a psychiatrist in Summerside, faced accusations related to his care of a pre-teen patient and of a male patient who is a registered nurse struggling with severe depression, agitation and “bizarre bodily complaints,” according to decision documents issued by the college. The case involving the boy led to an order to pay $9,000 in college costs and a peer review of up to 30 pediatric patient charts. For the case involving the nurse, Dr. Singh was hit with a $15,000 fine and $35,000 in college costs. He must also complete courses in effective communication and professionalism. The pediatric case stemmed from an appointment with a pre-teen boy, who came in with his stepmother and whose father called in by phone during the visit. Both adults expressed concern about their inability to control the patient’s behaviour and the safety of the five other children in their home. Read: Patient threatened him, his family and demanded 24/7 access: Doctor gets 8-month suspension in a ‘truly unique case’ Sometime during the appointment, Dr. Singh made a comment about sending the boy to a group home. “Partially in response” to these comments, according to the case document, the patient became “extremely upset, crying, aggressive and unable to be calmed down.” When the boy was admitted to hospital shortly after, his stepmother described the visit with Dr. Singh as “alarming.” During this time, nurses observed bruises on the boy’s upper right arm in the shape of four semi-circles. The cause of the bruising “is not clear,” according to the case document. During the investigation and hearing, Dr. Singh acknowledged physical contact with the patient and accepted responsibility for not maintaining a calm and controlled environment, and for failing to use appropriate techniques to de-escalate the situation. The college acknowledged there was no evidence Dr. Singh had meant to intentionally harm the patient. Read: What is forensic psychiatry? Explore the subspecialty with one of its founding members in Canada In the case involving the male nurse, a psychiatry expert hired by the college raised concerns about medication doses as well as Dr. Singh’s decision to use electroconvulsive therapy (ECT). The expert also questioned whether or not appropriate consent was obtained prior to the use of ECT. On a number of occasions, nurses documented the patient’s indecisiveness about undergoing ECT. On one particular day, one nurse noted that the patient and his spouse decided to go ahead with the procedure while another nurse wrote that the patient was unsure about ECT and that his spouse did not agree with it. The patient’s sister, who was present during one appointment, complained to the college that Dr. Singh had been disrespectful and unprofessional towards her brother. Dr. Singh explained to the college that he had been firm with the patient to encourage a return to function. During a subsequent visit to emergency, the patient was transferred to the care of another psychiatrist, who took him off the medication prescribed by Dr. Singh and prescribed another drug. The patient “brightened up almost immediately” and started to sleep better. Read: In a year of ER closures, N.L. sees five year high in emergency department deaths

Unexplained bruises and unclear consent: Doctor hit with $59K in fine and costs

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